Healthcare Provider Details

I. General information

NPI: 1033792874
Provider Name (Legal Business Name): JOSHUA ULMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 1ST AVE N
MOORHEAD MN
56560
US

IV. Provider business mailing address

3499 13TH AVE N APT 204
GRAND FORKS ND
58203-2189
US

V. Phone/Fax

Practice location:
  • Phone: 612-702-4861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: